Background: Cardiovascular disease (CVD) is a major health care concern in end-stage renal disease (ESRD). Peak oxygen uptake (VO_2peak) is a strong predictor of CVD and all-cause mortality, but its utility in ESRD patients is unknown.

Aim: Determine whether VO_2peak is a better predictor of CVD and all-cause mortality compared with troponin-T (established CVD risk marker in ESRD), among patients being evaluated for kidney transplant (TX).

Methods: In 2012 Mayo Clinic AZ incorporated VO_2peak into the CVD screening algorithm among high-risk patients being evaluated for kidney TX. High-risk patients (>50 years, ± history of diabetes, ± history of CVD) underwent VO_2peak testing, if VO_2peak is <17ml/kg/min MIBI is performed. Patients with documented VO_2peak testing and troponin T were followed for CVD events (non-fatal MI, ischemia, CABG, CVA and arrhythmia) and all-cause deaths. VO_2peak and troponin T were transformed to standardized scores (Z-score). The significance of these variables were tested using Cox proportional hazards, logistic regression models, and likelihood ratio statistics with/without adjustment for covariates (age, sex, race, hypertension, dyslipidemia, smoking, diabetes, and kidney tx status).

Results: During an average of 2.3 years follow-up among 374 patients, there were 57 cardiac events and 40 total deaths.

Both VO_2peak and troponin T were independent predictors of CVD events without adjustment for covariates. The hazard ratios (95% CI) for VO_2peak and troponin T were 0.62 (0.45, 0.85) and 1.29 (1.05, 1.58) for CVD events, respectively, as a single measure. After adjustment for covariates, higher VO_2peak [HR=0.58 (0.41, 0.81); p=0.002] was associated with lower risk of CVD events, but troponin T was not [HR=1.24 (0.99, 1.57); p=0.07]. Odds ratios (OR) for all-cause mortality were similar. After adjustment for covariates, higher VO_2peak was associated with lower risk of all-cause mortality [OR=0.55 (0.35, 0.87); p=0.01], but troponin T was nonsignificant [OR=1.20 (0.92, 1.58); p=0.18].

Conclusion: VO_2peak is a strong predictor of CVD events and all-cause mortality among ESRD patients being evaluated for TX and may have utility for risk stratification of these patients.

CITATION INFORMATION: Chakkera H, Lee C, Dickinson J, Kaplan B, Qaqish I, Behmen S, Heilman R, Khamash H, Huskey J, Nair S, Scott R, Steidley D, Temkit M, Angadi S. VO_2peak Outperforms Troponin T for Risk Prediction of Cardiovascular Disease and All-Cause Mortality in Patients with End Stage Renal Disease Being Evaluated for Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).

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